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《Chinese Journal of Orthopaedics》 2003-12
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The clinical study of computerized tomography myelography in diagnosing root avulsion of brachial plexus

WANG Shu-feng, ZHANG You-le, CHANG Wan-shen, et a l. Department of Hand Surgery, Beijing Jishuitan Hospital, Beijing 100035, China  
Objective To analyze the accuracy of computerized tomography my elography (CTM) to distinguish preganglionic injury of brachial plexus from post ganglionic as compared to the supraclavicular exploration of brachial plexus, an d evalute the outcome of follow up after operation. Methods From May 2001 to Mar ch 2003, 25 patients were admitted to our hospital, which included 21 males and 4 females aging from 4 to 45 years (mean, 24 years). Nineteen patients were take n preoperative CTM and then performed nerve exploration, release or repair opera tion, which were followed up 10 to 18 months; the other 6 patients with total br achial plexus injury were taken CTM after the first operation with partial recov ery, which were followed up 15 to 36 months. Spiral computerized tomography myel ography was examined 1-2 hours after intrathecal injection of 10 ml Isovist in a dult or 3-5 ml in children into the lumbar spine. CTM was obtained from C4 to T2 with 2 mm axial slices, and the scaning angle was parallel to the cervical disc s with the patient on supine position and the cervical spine unbent, while the b oth upper limbs were drawn distally. The criteria of CTM to identify preganglion ic or postganglionic injury depended on the absence or presence of dorsal and ve ntral rootlets intradually. Results Ninty-five cervical nerve roots (C5-T1) were evaluated by CTM preoperatively in these patients with brachial plexus injury, 90 of which cervical nerve roots were correctly diagnosed, and the accuracy rate was 94.7%. However, 48 cervical roots (C5-T1) were evaluated by electrophysiolo gy detecting in 13 patients with brachial plexus injury, 41 of which cervical ne rve roots were correctly diagnosed, and the accuracy rate was 85.4%, there was n o statistically significant difference between the two methods through chi-squar e test (÷2=3.48,P 0.05). Conclusion The ventral and dorsal rootlets of brach ial plexus especially the intradual C5~8 can be demonstrated clearly by CTM. The disappearance of ventral and dorsal rootlet of C5-T1 on CTM is a reliable index to determine the avulsion of cervical nerve roots. The results suggest that CTM is one of the best method to diagnose the preganglionic or postganglionic injur y of brachial plexus.
【CateGory Index】: R651.3
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